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HIPAA regulations and relations explained

May 5, 2022

HIPAA is a complex law that is often misunderstood. It’s more than a law that bars doctors and nurses from revealing medical information. In fact, if your company is in the healthcare industry, or does business with a company in the healthcare industry, there’s a good chance that understanding HIPAA is vital to your business’s survival.

What Is HIPAA law in healthcare and what does it regulate?

The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996 and has since gone through amendments and other changes. The original purpose of the law was to ensure that people could still access health insurance if they left their jobs, but today, the act also includes many regulations and requirements to help your healthcare information stay private and secure.

With a broad goal of maintaining confidentiality for protected health information (PHI), HIPAA uses several types of legal requirements to mandate confidentiality. It requires organizations to protect health data from unauthorized access, enact policies and protocols for their employees, and more.

The five rules of HIPAA

A helpful way to understand what HIPAA covers, in broad strokes, is to look at the five sections of the HIPAA law, known as the five rules of HIPAA. These include:

  • the privacy rule
  • the security rule 
  • the transactions rule 
  • the identifiers rule
  • the enforcement rule

The privacy rule details a concept called “right of access.” It gives patients the right to request access to their medical records and also enables patients to control who can and cannot access their medical records.

The security rule explains the precautions organizations need to put in place to keep patient information from being accessed without authorization. Those precautions and security controls span three categories: administrative security, technical security, and physical security.

The transactions rule provides a framework for proper use of medical codes such as ICD-9 and ICD-10 codes, CPT codes, and so on. These codes are used to specify medical conditions and procedures. They also ensure patient health records are accurate and can be understood by all healthcare providers.

The identifiers rule mandates the use of numeric identifiers for organizations and professionals in the healthcare industry. It specifically details three identifiers: national provider identifiers (NPIs), national health plan identifiers (NHPIs), and employer identification numbers (EINs).

Finally, the enforcement rule details how organizations can be penalized for HIPAA violations. HIPAA is enforced by the Office for Civil Rights within the U.S. Department of Health and Human Services. The enforcement rule details the multi-tiered penalty maximums and minimums for violations.

What is the importance of HIPAA compliance in healthcare?

HIPAA was enacted to protect critical private health information. It’s an important safety measure for both your business and your patients or clients.

HIPAA is important for clients or patients because it maintains the privacy of their health information. In the wrong hands, medical records can be used to harass, extort, bully, or discriminate against individuals in many aspects of their lives. Keeping this information confidential protects patients’ civil rights.

Following HIPAA also carries serious importance for your organization. Because HIPAA is an actively enforced law, violating or neglecting to follow its regulations can lead to heavy fines and, in some cases, even jail time. Some repeated violations could be enough to bankrupt your business. On a less severe note, following HIPAA also helps you to gain and maintain the trust of your patients or clients, which is vital in the healthcare industry.

Does my organization need to follow HIPAA regulations?

The regulations of HIPAA don’t apply to everyone—they only apply to specific types of organizations that are legally referred as “covered entities.” HIPAA details the various types of covered entities, but in a nutshell, it includes healthcare practices and providers, health insurance companies, government health plans, healthcare clearinghouses, and any business that associates with a covered entity and their PHI. 

Where should I start with HIPAA compliance?

If you’re unsure whether your organization is fully HIPAA compliant, the best place to begin is to find out which requirements you already meet and which ones need work. HIPAA is a complex law with many different components. Assessing your compliance manually would be a time-consuming and expensive task. Instead, an automated compliance platform can scan your system against the regulations of HIPAA to determine which requirements you meet and which should be on your to-do list. An automated platform can also compile documentation to use as evidence of your compliance.